Aesthetic surgeons performing lower lid blepharoplasty should consider using fractionated fat to blend the lid-cheek junction, according to a study published July 2018 in the Plastic and Reconstructive Surgery (PRS) journal.
Dallas-based board-certified plastic surgeon Rod J. Rohrich, M.D. at the Dallas Plastic Surgery Institute, and colleagues found that not only does fractionated fat, which he calls “fracto-fat,” appear to be as safe and effective as regular fat injections in blending the lid-cheek area, but fractionated fat seems to include viable fat cells. It’s not yet clear if viable fat cells in fractionated fat aid the regenerative process, they write.
The study is a retrospective analysis of fractionated fat injections Dr. Rohrich performed in 131 lower blepharoplasty patients from January 2014 to October 2015. Researchers compared those results to a similar cohort of lower blepharoplasty patients who had regular fat injections. Researchers prospectively compared histopathologic and gene expression of fractionated fat to regular fat in 12 patients.
A few points about how Dr. Rohrich harvests and emulsifies the fat, which, according to the study, differs from ways in which most providers harvest, prepare and use fractionated fat:
• Dr. Rohrich manually harvested the fat with low-pressure lipo-aspiration of the inner thigh, using a blunt 3-mm multiport cannula with 1-mm holes.
• His preference is to transfer autologous fat at the start of the procedure to maximize fat cell survival.
• He then prepares fractionated fat with mechanical emulsification during which he pushes the fat for 50 passes between two connected 10-cc syringes.
• This fracto-fat is viable adipose cells similar to regular adipose cells from each harvest, so it must be injected deep into the dermis to prevent lumps or fat nodules.
Patients results from fractionated fat lid-cheek junction blending were aesthetically pleasing at the time of follow-up, which ranged from 0 to 21 months. No nodules were found with the use fractionated fat cell injections placed below the orbicularis muscle at the eyelid-cheek junction. There was slightly more bruising and swelling in the fractionated fat group compared to those receiving regular fat injections. Skin quality improvements were subjectively visible at four to six weeks, according to the authors.
This study, they write, is the second published in the literature to show viable fat cells using fractionated fat prepared in such a manner. Mashiko T., et al. demonstrated viable cells were present in fractionated fat in a study published last year in Plastic and Reconstructive Surgery.
While the researchers write that fractionate fat is an option for adding volume to cheeks and other areas as it can potentially improve skin quality due to stem cell activity within viable fat cells.
“Fractionated fat is easy to use with smaller cannulas and delivers a large number of condensed adipose-derived stem cells using a very small volume of product,” they write. “Also, it can be used without any restrictions or regulations because it is an autologous product from the patient that has not been altered in any manner.”
The study’s average 6.5-month follow up and retrospective data collection were limitations of the research.
These experienced facial aging researchers, including the senior author Dr. Rohrich, encourage cosmetic surgeons to use fractionated fat to not only blend the specialized lid-cheek junction but also in the upper eyelids and lateral brow areas, which show early signs of hollowing due to the aging process.
Dr. Rohrich receives book royalties from Thieme Publishers and Instrument royalties from Micrins.
Rohrich RJ, Mahedia M, Shah N, Afrooz P, Vishvanath L, Gupta RK. Role of Fractionated Fat in Blending the Lid-Cheek Junction. Plast Reconstr Surg. 2018;142(1):56-65.